International Journal of Anatomy and Research,
Int J Anat Res 2014, Vol 2(1):239-41. ISSN 2321- 4287
Case Report
UNILATERAL TRIPLE RENAL VEINS AND BILATERAL DOUBLE RENAL
ARTERIES- AN UNIQUE CASE REPORT
Gyan Prakash Mishra *1, Shobha Bhatnagar 2, Brijendra Singh 3.
*1
Assistant Professor of Anatomy, Career Institute of Medical Sciences and Hospitals.
Professor & Head, Dept. Of Anatomy, Career Institute of Medical Sciences and Hospitals.
3
Additional Professor of Anatomy, AIIMS Jodhpur, India.
ABSTRACT
2
A precise knowledge of the vascular variations of human kidney is essential for the surgeon and radiologist to
avoid complication during interventional radiological procedure, renal transplantation, renal trauma and other
urological procedures. The present case report is regarding unilateral variation of renal vein and bilateral variation
of renal artery. During routine cadaveric dissection of abdominal region, we observed three renal veins in right
kidney. All right renal veins were emerging from hilum of kidney and drained in inferior vena cava where as in
left Kidney venous drainage is normal.
In right Kidney both main and accessory renal artery arose from abdominal aorta. Left main renal artery arose
from abdominal aorta with left accessory renal artery arising from left middle suprarenal artery which is branch
of coeliac trunk. In this case right ureteropelvic junction is seen to be compressed in between right accessory
renal artery and right lower renal vein which crossed anteriorly with right middle renal vein crossing posteriorly
this condition may cause hydronephrosis. The above finding to be reported in a single case is rarely seen. This
is a valuable contribution from anatomical knowledge to operative procedures.
KEYWORDS: Renal artery; Accessory renal artery; Renal vein; Kidney; Ureteropelvic junction.
Address for Correspondence: Dr. Gyan Prakash Mishra, H.No.: 317, Shiv Vihar Colony, Sector-1,
Jankipuram, Lucknow, India-226021. E-Mail: [email protected]
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ISSN 2321-4287
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Received: 05 Feb 2014
Peer Review: 05 Feb 2014 Published (O):30 March 2014
Accepted: 27 Feb 2014
Published (P):30 March 2014
INTRODUCTION
Normally each kidney supplied by single renal
vessels. Variations in the renal vessels are
frequently seen but presence of accessory
renal arteries is most common variation. They
develop from persistent embryonic lateral
splanchnic arteries and usually arise from aorta.
Rarely accessory renal arteries arise from the
coeliac or superior mesenteric arteries or from
the common iliac arteries [1] variations in renal
venous pattern is less common as compared to
arterial pattern. Second additional renal veins
occur infrequently on the right side (5%) [2]. In
the present case we found three renal veins on
right Kidney with bilateral single accessory
renal artery. These anatomical variations are
Int J Anat Res 2014, 2(1):239-41. ISSN 2321-4287
important to know before performing any
invasive diagnostic and interventional
procedures in renal diseases.
CASE REPORT
The renal vasculature variations were found in
adult male cadaver during the routine dissection
of abdomen in Department of Anatomy Career
Institute of Medical Sciences and Hospital,
Lucknow. In right kidney three renal veins were
seen, namely upper, middle and lower right renal
vein. Upper right renal vein was emerging from
upper part of hilum at level of L1 vertebra,
passed superomedially and drained into the
inferior vena cava. Middle right renal vein was
239
Gyan Prakash Mishra et al., UNILATERAL TRIPLE RENAL VEINS AND BILATERAL DOUBLE RENAL ARTERIES- AN UNIQUE CASE REPORT.
emerging from middle part of hilum at level of
intervertribral disc between L1 and L2, passed
superomedially and drained into the inferior
vena cava. Lower right renal vein was emerging
from lower part of hilum at level of L2 vertebra,
passed inferomedially and drained into the
inferior vena cava. Lower right renal vein was
crossing anterior to right ureteropelvic junction
and middle right vein was crossing posterior to
it.
In both right and left kidney two renal arteries
were observed showing bilateral variation in
renal artery. Right main renal artery arose from
anterolateral surface of abdominal aorta just
below the superior mesenteric artery. The right
main renal artery immediately after its origin
gave a branch named right hilar artery further
running inferolaterally gave another branch
named right superior polar artery in its further
course the main renal artery reached the
central portion of hilum. Right hilar artery gave
a branch to right suprarenal gland (Lower suprarenal artery) and entered the upper end of the
hilum. Right superior polar artery was running
superolaterally and reaching the superior pole
Fig.1: Posterior View Showing Triple Right Renal Veins
And Bilateral Double Renal Arteries.
of right kidney. Right accessory renal artery
originated from anterior surface of abdominal
aorta 15mm below the superior meserteric
artery and ran inferolaterally after crossing the
right uerteropelvic junction anteriorly reached
the lower end of hilum. Left main renal artery
took origin from posterolateral surface of
abdominal aorta 12mm below the superior
mesenteric artery. Left main renal artery on its
course running laterally gave a branch named left
hilar artery and reached the hilum of left
kidney. Left hilar artery was reaching the upper
end of hilum. Left accessory renal artery arose
from left middle suprarenal artery which was
branch of coeliac trunk. Left accessory renal
artery was running inferolaterally and entering
in hilum of left kidney.
DISCUSSION
On the basis of many studies it has been accepted that the high frequency of variations are
present in renal vessels. Variation in renal arterial pattern is more common as compared to
venous pattern. Second additional renal veins
occurred infrequently on the right side (5%) [2].
Variations of right renal veins are more common
than the left [3]. The incidents of addition renal
Fig.2: Anterior View of Right and Left Kidney Showing
Renal Vascular Variations.
A-Right kidney, B- Left Kidney, C- Abdominal Aorta,
D- Inferior Vena Cava, E- Right Upper Renal Vein, F- Right
Middle Renal Vein, G- Right Lower Renal Vein , H- Right
Suprarenal Gland, I- Left Suprarenal Gland, J- Right Ureteropelvic Junction, K- Right Main Renal Artery, L- Right
Accessory Renal Artery, M- Right Hilar Artery, N- Right
Polar Artery, O- Right Lower Suprarenal Artery, R- Left
Middle Suprarenal Artery, S- Left Main Renal Artery,
T- Left Accessory Renal Artery, U- Left Hilar Artery,
X-Suprarenal Artery.
Int J Anat Res 2014, 2(1):239-41. ISSN 2321-4287
A- Right kidney, B- Left Kidney, C- Abdominal Aorta,
D- Inferior Vena Cava, E- Right Upper Renal Vein, F- Right
Middle Renal Vein, G- Right Lower Renal Vein , H- Right
Suprarenal Gland, I- Left Suprarenal Gland, J- Right Ureteropelvic Junction, L- Right Accessory Renal Artery,
P- Coeliac Trunk, Q- Superior Mesenteric Artery,
R- Middle Suprarenal Artery, V- Left Renal Vein, W- Left
Suprarenal vein.
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Gyan Prakash Mishra et al., UNILATERAL TRIPLE RENAL VEINS AND BILATERAL DOUBLE RENAL ARTERIES- AN UNIQUE CASE REPORT.
veins reported to be 3.3% on right side and 2.6%
on left [4]. Presence of multiple right renal vein
(more than 2 veins) was found in about 8.0%to
9.7% of cases [5]. A rare case of venous
drainage anomalous, was found three renal veins
draining the right kidney [6]. This finding is
similar to our finding for right renal veins. Renal
venous variations are rare compared to arteries
[7]. Accessory renal arteries were observed
unilateral in 15% cases and bilateral on 5% of
cases [8]. In the study of 170 cases, found that
36 of 170 subjects (21.2%) had multiple arterial
origins on the left or right side, and 8 subjects
(4.7%) had bilateral multiple arterial origins. [9].
Bilateral frequency of first additional renal artery
as 10.2% [10]. 54 double renal arteries originating from the aorta in 272 kidneys (20%) and 6 of
them were bilateral (2.2%)[11]. In our study we
found bilateral double renal artery. All the
additional vessels were located posterior to the
ureter with a close relationship to the ureteropelvic junction on the right side [12]. The
incidence of additional renal arteries has a wide
range (from 8.7% to 75.7%) and they too, can
cause hydronephrosis by obstruction [13]. In our
study right ureteropelvic junction is seen to be
compressed in between right accessory renal
artery and right lower renal vein which crossed
anteriorly with right middle renal vein crossing
posteriorly this condition may cause
hydronephrosis.
CONCLUSION
In this case report the variations of renal vascular
pattern included triple right renal vein and
bilateral double renal artery with the point to
be emphasized is the emerging of additional
right renal vein and origin of bilateral single
accessory renal artery.
One of the main finding is that right ureteropelvic
junction is seen to be compressed in between
right accessory renal artery and right lower renal
vein which crossed anteriorly with right middle
renal vein crossing posteriorly this condition may
cause hydronephorosis. The main aim of this
case report is to recognize presence of variations
in renal vessels which must be kept in mind by
surgeon and other related experts before
performing any operative procedure such as
renal transplants, vascular reconstructions,
nephrectomies and trauma management to
Int J Anat Res 2014, 2(1):239-41. ISSN 2321-4287
avoid pre and post operative complications.
Conflicts of Interests: None
REFERENCES
[1].
Standring S ed . Grays anatomy. The anatomical
basis of clinical practice. 40th Ed. Ederburg.
Churchill and Livingstone. 2008:1231.
[2]. Satyapal KS, Kalideen JM, Haffejee AA, Singh B and
Robbs JV. Left renal vein variations. Surg Radiol Anat
1999, 21:77- 81.
[3]. Nayak BS. Multiple variations of the right renal
vessels. Singapore Med J. 2008, 49:153- 155.
[4]. Sampio FJ, Passos MA. Renal arteries: anatomic
study for surgical and radiological practice. Surg
Radiol Anat. 1992; 14:113-117.
[5]. Baptista - Silva, J.C. , Verissimo, M.J. & Castro, M.J.,
Camara, A.L. & Pestana, J.O. Anatomical study of
the renal veins observed during 342 living –donor
nephrectomies. Rev. Paul. Med. 1997, 115 (3) : 1456
– 1459.
[6]. Fernandes, R.M.P. , Conte , F.H.P., Favorito, L.A.,
Abidu – Figueiredo, M - & Babinski, M.A. Triple right
renal vein: An uncommon variation : Int .J. Morphol
2005,23(3):231-233.
[7]. Sykes D. The arterial supply of the human kidney
with special reference accessory renal arteries. Br.
Jr. Surg. 1963, 50: 368-370.
[8]. Dhar P, Lal K. Main and accessory renal arteries- a
morphological study. Ital J Anat Embryol. 2005;
110:101-110.
[9]. Kaneko N, Kobayashi Y, Okada Y, Anatomic variations
of the renal vessels pertinent to transperitoneal
vascular control in the Management of trauma.
Surgery. 2008; 143: 616-622.
[10]. Satyapal K.S., Haffejee AA, Singh B, Ramsaroop L,
Robbs JV,kalideen JM. Additional renal arteries:
incidence and morphometry. Surg Radiol Anat.
2000; 23: 33-38.
[11]. Bordei P, Sapte E, Iliescu D. Double renal arteries
originating from the aorta. Surg Radiol Anat. 2004;
28: 474-479.
[12]. Bayramoglu A, Demiryurek D, Erbil KM, Bilateral
additional renal arteries and an additional right
renal vein associated with unrotated kidneys. Saudi
Med J. 2003;24: 535-537.
[13]. Edman G; Accessory vessels of the kidney and their
diagnosis in hydronephrosis. Acta Radiol
Stockh.1954,42 : 26-32.
How to cite this article:
Gyan Prakash Mishra, Shobha Bhatnagar,
Brijendra Singh. UNILATERAL TRIPLE RENAL
VEINS AND BILATERAL DOUBLE RENAL
ARTERIES- AN UNIQUE CASE REPORT. Int J
Anat Res 2014;2(1):239-41.
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